Elsevier

Resuscitation

Volume 47, Issue 2, October 2000, Pages 125-135
Resuscitation

Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines

https://doi.org/10.1016/S0300-9572(00)00212-4Get rights and content

Abstract

Aim: To assess the effectiveness of the ILCOR Advisory Statements on Advanced Life Support adopted by the Resuscitation Council (UK), as the standard for resuscitation following cardiac arrest. Method: Over the period May to November 1997, data on the process and outcome of cardiopulmonary resuscitation following in-hospital cardiac arrest were collected from 49 hospitals throughout the UK. Results: Of 2074 audit forms submitted, 1368 were included in the final analysis. The initial rhythm monitored was ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in 429 patients, of whom 181 (42.2%) were discharged alive, compared to 6.2% when the initial rhythm was non-VF/VT. Overall, 240 (17.6%) patients were discharged alive. At 6 months after discharge 195 (82.3%) of 237 patients were still alive. Successful initial resuscitation, defined as return of spontaneous circulation lasting longer than 20 min (ROSC>20 min), was significantly associated with VF/VT as the initial arrest rhythm, return of circulation in less than 3 min, age less than 70 years and the use of an advanced airway (P<0.01). There was a significant increased likelihood of survival to discharge when the circulation was restored in less than 3 min and age was less than 70 years (P<0.05). The administration of any adrenaline (epinephrine) was significantly associated with a reduced likelihood of ROSC>20 min or alive discharge (P<0.0001). Conclusion: Compared to the last major multiple hospital study published in 1992, the results of this study suggest that there appears to have been an improvement in survival of in-hospital patients in the UK who have a VF/VT cardiac arrest. How much of this is directly attributable to the adoption of the latest guidelines is uncertain.

Introduction

In 1992 the European Resuscitation Council (ERC) published the first set of internationally recognized guidelines for Advanced Life Support [1]. These were based upon scientific and clinical information available at that time, recognizing that as further information became available, there would be the need for modification. In 1997, the International Liaison Committee on Resuscitation (ILCOR) issued their Advisory Statement on Advanced Life Support (ALS) [2]. The mainstay of this statement was the proposal of a universal algorithm, which emphasized the importance of early identification of VF/pulseless VT and rapid defibrillation. In April 1997, the Resuscitation Council UK decided to adopt the advisory statements on behalf of the European Resuscitation Council (ERC). The aim of this study was to try and assess the effect of implementing the 1997 guidelines by auditing outcome following cardiac arrest in a group of hospitals throughout the UK.

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Materials and methods

Resuscitation Training Officers (RTOs) in District General and Teaching hospitals throughout the UK were recruited to gather data on in-hospital cardiac arrests occurring in adults (>16 years of age) in the 6-month period, May–November 1997. Patients undergoing cardiopulmonary resuscitation on arrival at hospital were excluded. The data for each cardiac arrest were collected using a standardized form based upon the recommendations of Cummins and colleagues for in-hospital cardiac arrests [3].

Results

Details of in-hospital resuscitation attempts were obtained from the RTOs in 49 hospitals. The total number of cardiac arrest calls logged by hospital switchboards during the study period was 3942, not all of which were to patients requiring cardiopulmonary resuscitation. Analysis of cases in those hospitals which were able to identified the true reason for the call showed that only 2477 out of 3366 (73.6%) were to patients requiring cardiopulmonary resuscitation.

The total number of audit forms

Discussion

The aim was to assess the impact of adopting the ILCOR advisory statement for the management of in-hospital cardiac arrest in adults. It is well recognized that audit of resuscitation and collection of reliable data are difficult. The present study set out to try and audit all cardiopulmonary resuscitations in participating hospitals, but our data suggest that identification of all such events may not be possible. Hospitals frequently initiate a ‘cardiac arrest’ call incorrectly or simply

Acknowledgements

The authors would like to express their sincere thanks to the Resuscitation Council (UK) for funding this study and to the following RTOs who submitted data: Celia Warlow, Joanne Atkinson, Mark Whitbread, Mike Harris, Jane Roberts, Colin Murray, Noreen Lewis, Keith Bruce, Kevin McCusker, Pat Snowden, Carolyn Williams, Nikki Douglas, Peter Snell, Shaun Essery, Susan Dowling, Jill Tempest, June Conners, Katherine Basset, Rose Oughton, Brenda Cottam, Susan Barber, Dave Edwards, Ken Spearpoint,

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